The Cleveland Clinic has reached a settlement with the Department of Justice, agreeing to provide $2 million in detransition services and halt gender-affirming care for minors for two decades, marking the second major health system to strike such a deal with the Trump administration.
Under the agreement announced Friday, the clinic will offer detransition care—including hormonal balancing, surgical revision, fertility restoration, and psychological support—to all patients regardless of ability to pay. It must also set up a dedicated website, phone line, and care coordinator, and reach out to three organizations providing non-medical detransition support.
Federal and state officials alleged the Cleveland Clinic used diagnosis codes for unspecified endocrine disorders instead of more accurate codes for gender-affirming procedures, a practice they contend amounted to fraudulent billing. The settlement requires the clinic to pay just over $300,000 to the U.S. and Ohio to resolve those allegations.
DOJ Associate Attorney General Stanley Woodward framed the deal as protecting children, stating: “The Department of Justice is steadfastly committed to protecting America’s children. Just as the resolution with Texas Children’s, today’s resolution with Cleveland Clinic furthers that commitment and puts these providers on notice that this Department will vigorously enforce federal law where children are put at risk.”
The clinic also pledged a 20-year ban on providing puberty blockers and cross-sex hormones to minors—though Ohio state law already prohibits such care. The Hill has sought comment from the Cleveland Clinic.
Transgender advocates sharply criticized the settlement. Dara Adkison, executive director of TransOhio, called it a “capitulation,” saying: “Cleveland Clinic, once a highly respected medical institution, continues to show that maintaining medical integrity is no longer their priority by jumping to the front of the line to comply not with science and medicine, but with cruelty and anti-trans hate.” Adkison added that detransition services were already part of gender-affirming care and called the agreement a “bigoted, sad performative farce.”
This settlement follows a similar deal last month with Texas Children’s Hospital, which paid $10 million and established the nation’s first dedicated detransition clinic. The Cleveland Clinic’s financial penalty is far smaller, but the 20-year commitment to withhold care from minors mirrors the Texas case.
The DOJ’s statement said the clinic’s funding will “provide essential medical care for individuals living with the harmful consequences of such misguided medical interventions performed on them as children and adolescents.” The settlement also requires the clinic to publicize detransition services widely.
The broader political context includes ongoing battles over transgender rights, with the Trump administration targeting gender-affirming care for minors. Meanwhile, the Title IX fight over transgender athletes shows no sign of compromise, and Democrats are already planning investigations and potential prosecutions of Trump officials.
Critics argue the settlement sets a dangerous precedent, pressuring health systems to abandon evidence-based care under legal threats. Supporters contend it holds providers accountable for billing practices and protects minors from irreversible procedures.
